Provider Demographics
NPI:1225214125
Name:LOUIS L. ENDRESS DPM
Entity Type:Organization
Organization Name:LOUIS L. ENDRESS DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ENDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-334-7617
Mailing Address - Street 1:120 PONDVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-9639
Mailing Address - Country:US
Mailing Address - Phone:330-334-7617
Mailing Address - Fax:330-334-6232
Practice Address - Street 1:2914 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1655
Practice Address - Country:US
Practice Address - Phone:330-262-5106
Practice Address - Fax:330-334-6232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-001566213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0534180001Medicare NSC